Documentation (content) - ANS Proper code assignment is determined both by _____________ in the medical record and by the unique rules that govern each
... [Show More] code set in that instance
An auditor - ANS The role a coder may take on to verify that the documentation supports the codes the physician has selected
Query the physician - ANS If the medical record is inaccurate or incomplete, it will not translate properly to the language of codes. What can a coder do in order for the medical record to be complete and accurate so they can bill properly?
Quarterly (usually) - ANS How often are codes and insurance payment policies updated?
NPP - ANS Non-Physician Provider (also known as mid-level providers or physician extenders)
PA - ANS Physician assistant
NP - ANS Nurse practitioner
Commercial and Government - ANS The two types of primary insurances
Commercial Carriers - ANS Private payers that may offer both group and individual plans
Medicare - ANS The most significant government insurer; a federal health insurance program
People over 65, blind or disabled individuals, and people with permanent kidney failure or end-stage renal disease - ANS Medicare provides coverage for what kind of people?
ESRD - ANS end-stage renal disease
Medicare Part A - ANS Helps cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice care, and home healthcare,
Medicare Part B - ANS Covers medically necessary physicians' services, outpatient care, and other medical services (including some preventive services) not covered under Medicare Part A. It can be an optional benefit.
Medicare Part C - ANS Also called Medicare Advantage, combines the benefits of Medicare Part A, Part B, and-sometimes- Part D. The plans are managed by private insurers approved by Medicare.
Medicare Part D - ANS A prescription drug program available to all Medicare beneficiaries.
Medicaid - ANS A health insurance assistance program for some low-income people (especially children and pregnant women) sponsored by federal and state governments.
RBRVS - ANS Resource-Based Relative Value Scale
Resource-Based Relative Value Scale (RBRVS) - ANS Medicare payments for physician services are standardized using _____ and are divided into three components.
The physician work component, practice expense, and professional liability insurance (PLI) - ANS The three components used to determine resource cost for physician services.
The Physician Work component - ANS Accounts for just over half (52 percent) of a procedure's/service's total relative value and is measured by time it takes to perform a service, technical skill, and physical effort. [Show Less]